Brain abscess with Ureaplasma parvum in a patient with granulomatosis with polyangiitis

Abstract

Purpose Ureaplasma species are associated with urogenital infections, infertility and adverse pregnancy outcomes as well as neonatal infections. Involvement of the central nervous system in adults is extremely rare. We report an unusual case of a brain abscess secondary to otitis media with Ureaplasma parvum in a patient with granulomatosis with polyangiitis (GPA). Methods Imaging and laboratory findings, treatment decisions, and outcome of this case are explicated. Results A young adult with GPA presented with progredient earache after ambulant diagnosis of otitis media. Despite different courses of broad-spectrum antibiotic therapy, she developed meningoencephalitis due to mastoiditis following temporal abscess formation. Mastoidectomy and neurosurgical abscess removal were performed. Standard cultures of cerebrospinal fluid, blood and intracranial abscess material, as well as polymerase chain reaction (PCR) for common bacterial and viral meningitis pathogens remained negative. Only eubacterial PCR of intracranial abscess material returned positive for Ureaplasma parvum. The patient finally improved under antibiotic therapy with moxifloxacin and doxycycline. Conclusion Ureaplasma species are rare causative pathogens in immunocompromised patients. They should be considered in patients with humoral immunodeficiencies with culture-negative infections failing standard therapy. Eubacterial PCR should be performed in early states of infection in these patients for immediate diagnosis and initiation of appropriate treatment to prevent adverse outcomes.

Immunocompromised teenager with meningitis caused byUreaplasma parvum

“…Ureaplasma as a cause of infection in the central nervous system is considered extremely rare in adults. Only a few cases on adult CNS infections with Ureaplasma exist as of today 10–14 27. Three of them report concomitant hypogammaglobulinaemia, similar to our patient 12 14 27.…”

“…Only a few cases on adult CNS infections with Ureaplasma exist as of today 10–14 27. Three of them report concomitant hypogammaglobulinaemia, similar to our patient 12 14 27. Two other cases describe prior brain surgery10 11 and one case a complicated kidney transplantation and organ rejection before onset of Ureaplasma meningitis 13.…”

“…In adults, Ureaplasma as a cause of infection outside the genitourinary tract is uncommon, regardless of immune status. We have found only five previously published cases of adult Ureaplasma meningitis 10–14. Although rare, several recent case reports on serious infections with Ureaplasma in immunocompromised patients indicate that this may be a relevant and probably underdiagnosed pathogen that should be considered, especially in this patient population.…”

“…Patients with humoral immunodeficiency—both primary and acquired—seem particularly at risk. In the past three decades, seven cases of invasive Ureaplasma disease have been reported in patients with common variable immunodeficiency/agammaglobulinaemia, in 1 patient with the immunodeficiency disorder Good’s syndrome14–20 and in at least 19 cases of patients receiving B-cell depletion therapy with rituximab 12 21–38. Hypogammaglobulinaemia is frequently observed in patients treated with rituximab 39 40…”

“…We have found only five previously published cases of adult Ureaplasma meningitis. [10][11][12][13][14] Although rare, several recent case reports on serious infections with Ureaplasma in immunocompromised patients indicate that this may be a relevant and probably underdiagnosed pathogen that should be considered, especially in this patient population. Patients with humoral immunodeficiency-both primary and acquired-seem particularly at risk.…”